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The Urologic Clinics of North America May 1995In properly selected patients, TURP has the highest probability of symptom relief of any strategy of BPH management except open prostatectomy, the outcomes of which are... (Review)
Review
In properly selected patients, TURP has the highest probability of symptom relief of any strategy of BPH management except open prostatectomy, the outcomes of which are but marginally better. However, open prostatectomy suffers from lack of patient acceptance, increased postoperative discomfort, and prolonged hospitalization, factors which over the past six decades relegated it to a minor role in the surgical management of BPH. Given the advanced age and compromised health status of most men undergoing TURP, the procedure's current mortality, morbidity, and long-term complication rates are remarkable. The ultimate role of the emerging alternative strategies of BPH management--hormonal, pharmacologic, thermal, and device discussed elsewhere in this issue, will be dependent upon their durability and their long-term outcomes, which remain to be fully defined. In the meantime, TURP remains the standard against which all new therapies must be measured. The resectoscope is being challenged but is not yet ready for the history books.
Topics: Humans; Intraoperative Complications; Male; Postoperative Complications; Prostatectomy
PubMed: 7762111
DOI: No ID Found -
Current Urology Reports Sep 2017Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative... (Review)
Review
PURPOSE OF REVIEW
Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative erectile dysfunction (ED). The aim of this study is to summarize the current literature on surgical techniques for managing post-prostatectomy erectile dysfunction.
RECENT FINDINGS
The PubMed database was searched for English-language articles published up to Jan 2017 using the following search terms: "prostatectomy AND erectile dysfunction", "prostatectomy AND penile prostheses", and "prostatectomy AND penile implants". All of the studies that evaluated medical treatment were excluded. In the last few decades, the understanding of the anatomy of the male pelvis and prostate has improved. This has led to significant changes in the nerve-sparing radical prostatectomy techniques, with the aim of preserving post-surgical erectile function (EF). In this scenario, the prostate vascular supply and the anatomy of the neurovascular bundles have a central role. Penile prosthesis implantation is considered the third-line treatment option for RP ED patients, and they have been reported to be a very successful treatment with the highest patient satisfaction rate. Considering the failure of penile rehabilitation, and the lack of evidence for accessory pudendal artery (APA) preservation and nerve graft, nerve-sparing surgery and penile prostheses represent, today, the only methods to permanently and definitively preserve or erectile function after RP.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penis; Prostatectomy; Prostatic Neoplasms
PubMed: 28965315
DOI: 10.1007/s11934-017-0735-2 -
Acta Clinica Croatica Oct 2022Mininimally invasive surgery has become one of the most popular ones over the last few decades due to many benefits. The advantages are minimal surgical incision,... (Review)
Review
Mininimally invasive surgery has become one of the most popular ones over the last few decades due to many benefits. The advantages are minimal surgical incision, reduced blood loss, reduced postoperative pain, faster postoperative recovery, shorter hospital stay, lower morbidity and better outcomes compared to open surgery. The most common robotic procedures in urology are radical prostatectomies. In UHC Zagreb, since November 2019 until now, there have been more than 180 robotic assisted radical prostatectomies (RALP) using Senhance robotic system performed. As a procedure with many possible complications, it represents a challenge for anaesthesiologist. Some of the problems the anaesthesiologists have to face are related to limited patient access, possible difficulties connected with positioning, pneumoperitoneum, subcutaneous emphysema, possible airway oedema. Pneumoperitoneum has impact on almost every system: cardiovascular, renal, respiratory, gastrointestinal and other. Detailed understanding of physiological changes of RALP, with intraoperative impact on nearly every body system is ultimate. Careful preoperative evaluation and intraoperative conduction minimize the risk of complications, and help patients to reach full recovery in a very short time. Excellent outcomes are the result of individualized approach to the patient and good communication between team members.
Topics: Male; Humans; Robotic Surgical Procedures; Robotics; Pneumoperitoneum; Laparoscopy; Anesthesia; Prostatectomy; Postoperative Complications
PubMed: 36938550
DOI: 10.20471/acc.2022.61.s3.11 -
Gan To Kagaku Ryoho. Cancer &... Jul 2012Robot-assisted radical prostatectomy(RARP)has emerged in the last decade. It has greatly improved clinical management of localized prostate cancer. Its use has been... (Review)
Review
Robot-assisted radical prostatectomy(RARP)has emerged in the last decade. It has greatly improved clinical management of localized prostate cancer. Its use has been justified by its satisfactory oncological and functional outcomes and its fewer perioperative complications. RARP has the advantages of both conventional open radical retropubic prostatectomy and laparoscopic radical prostatectomy. However, its increased cost and the lack of tactile sensation it induces still remain problems.
Topics: Humans; Male; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Robotics
PubMed: 22790035
DOI: No ID Found -
Future Oncology (London, England) 2015Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the... (Review)
Review
Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the USA are performed using this approach. Interestingly, the broad dissemination of RARP occurred in the absence of comprehensive data coming from prospective randomized trials supporting the superiority of RARP versus the conventional open RP (ORP). Only observations originating from retrospective institutional or large population-based cohorts exist with respect to the comparative effectiveness of the two surgical techniques. What we have learned is that, given an adequate learning curve, RARP leads to better perioperative and long-term functional outcomes compared with ORP, without any compromise to cancer control outcomes. That being said, the substantially higher costs associated with the use of robotics cannot be ignored.
Topics: Humans; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 26358012
DOI: 10.2217/fon.15.169 -
The Urologic Clinics of North America Aug 2001Historically, radical prostatectomy is a surgical technique associated with significant morbidity. The ability to minimize intraoperative bleeding and preserve... (Review)
Review
Historically, radical prostatectomy is a surgical technique associated with significant morbidity. The ability to minimize intraoperative bleeding and preserve continence and potency requires a comprehensive understanding of pelvic anatomy, meticulous surgical technique, and appropriate surgical instruments. The anatomic radical retropubic prostatectomy first described by Walsh in 1982 represents a technique in evolution. The detailed surgical approach for anatomic radical retropubic prostatectomy described in this article represents the author's technique that has been developed after performing over 2,000 radical prostatectomies since 1986. The step by step illustrations and description of technique are designed to aid the urologic surgeon develop an efficient approach to this surgical procedure.
Topics: Humans; Male; Postoperative Care; Preoperative Care; Prostatectomy; Prostatic Neoplasms
PubMed: 11590810
DOI: 10.1016/s0094-0143(05)70159-2 -
BJU International Oct 2003
Review
Topics: Costs and Cost Analysis; Endoscopy; Humans; Laser Therapy; Male; Prostatectomy; Prostatic Hyperplasia; Treatment Outcome
PubMed: 14511026
DOI: 10.1046/j.1464-410x.2003.04426.x -
Sexual Medicine Reviews Apr 2018The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual... (Review)
Review
INTRODUCTION
The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual dysfunction in patients and their intimate partners.
AIM
To identify predictors of sexual satisfaction in prostate cancer survivors and their partners based on a review of the current literature.
METHODS
We performed a comprehensive review of the PubMed database from January 2000 to May 2017 focused on the (i) prevalence of patient and partner sexual dysfunction related to radical prostatectomy, (ii) differences in patient and partner perspectives of sexual function and dysfunction, and (iii) predictors of patient and partner sexual satisfaction after radical prostatectomy.
MAIN OUTCOME MEASURES
Patient- and partner-reported sexual satisfaction.
RESULTS
There is a paucity of published data examining sexual satisfaction in prostate cancer survivors and their partners. Patients and partners can have different expectations of sexual outcomes after radical prostatectomy and different attitudes toward the relative importance of recovery of sexual function after surgery. Available data suggest that patients' and partners' mental and physical health and the quality of communication between them are important contributors to their sexual satisfaction. Patient-perceived partner support also is associated with better patient-reported erectile function and greater relationship satisfaction.
CONCLUSION
Mental health, physical health, quality of interpersonal communication, and patient-perceived partner support appear to be the most important predictors of sexual satisfaction for patients and partners in the post-prostatectomy period. There is a definite need for further research on this topic to develop interventions to improve sexual function and quality of life for prostate cancer survivors and their intimate partners. Guercio C, Mehta A. Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy. Sex Med Rev 2018;6:295-301.
Topics: Female; Humans; Male; Orgasm; Personal Satisfaction; Prostatectomy; Prostatic Neoplasms; Sexual Dysfunction, Physiological; Sexual Partners
PubMed: 29128271
DOI: 10.1016/j.sxmr.2017.08.005 -
Minerva Urologica E Nefrologica = the... Mar 2015Over the past decade, the robotic assisted radical prostatectomy (RARP) has grown increasingly popular and quickly equated itself as the most commonly used modality to... (Review)
Review
Over the past decade, the robotic assisted radical prostatectomy (RARP) has grown increasingly popular and quickly equated itself as the most commonly used modality to treat locally-confined prostate cancer. Despite increased utilization, there is limited comparative research demonstrating superiority for RARP over the conventional radical retropubic prostatectomy (RRP). Furthermore, though perioperative and short-term oncologic outcomes are equivalent if not superior for the robotic approach, the optimal utilization of robotic technology remains to be determined with cost serving as a primary driver. In this review, we performed a literature search to identify comparative effectiveness research as it pertains to RARP versus RRP. We performed a PubMed literature search for a review of articles published between 2000 and 2014 using the following keywords to identify pertinent research: "robot or robotic prostatectomy", "open or retropubic prostatectomy", "cost", "resource utilization". Long-term data comparing RARP and RRP remains limited, though short-term positive surgical margins, biochemical recurrence-free survival, and need for adjuvant therapy appear at least equivocal, if not in favor of RARP versus RRP. Functional outcomes including return of continence and potency favor RARP while cost still favors RRP. Nonetheless, the generalization of results remains difficult with surgeon volume playing a large role in improving efficiency and quality. For the foreseeable future, an increasing number of prostatectomies will continue to be performed robotically. Though RARP appears to offer improved functional outcomes with good short-term oncologic outcomes, there is a need for longer-term studies to assess the true value of RARP. Outcomes aside, rigorous, prospective randomized-controlled trials must also be performed on the cost-effectiveness of RARP to determine its overall utility in an era of health care delivery reform.
Topics: Cost-Benefit Analysis; Evidence-Based Medicine; Humans; Los Angeles; Male; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures; Treatment Outcome
PubMed: 25424387
DOI: No ID Found -
Journal of Perioperative Practice Mar 2019
Topics: History, 19th Century; History, 20th Century; Humans; Male; Prostatectomy
PubMed: 30035695
DOI: 10.1177/1750458918790183